The Coronavirus Economy: Working as a therapist in an anxious time

This is a difficult time for practicing mental health. Therapists know it.

LaToya Gaines, a clinical psychologist based in New York City, has a private practice and also works as a staff psychologist at the campus counseling center at Rutgers University in Newark. “In both places, I have seen an increase in referrals,” she says.

Gaines has had to transition to virtual therapy under stay-at-home orders. Some of her clients who didn’t find the new model ideal chose to suspend treatment for the time being. But that has given her openings to accept new referrals, and she has been getting inquiries: “Some in need of services to cope with situations related to the pandemic, and others wanting to commit to therapy for some time whom the pandemic has given the ‘boost’ to get started.”

At the university, the counseling center was and remains popular. Gaines says students are calling in for appointments.

Fortune spoke with Gaines for a new series, The Coronavirus Economy, to ask about how COVID-19 has affected her work as a therapist. She also shared some advice for people experiencing coronavirus-induced anxiety at the moment. The following Q&A has been condensed and lightly edited for clarity.

LaToya Gaines

Fortune: What do you find yourself discussing with your clients lately?

Gaines: In both settings, I am definitely discussing how to exist within this “new normal.” Having such a sudden and drastic change in lifestyle has been jarring for people, and the work has been focused on how to adjust in the best way possible. 

For my students, they have had to transition to distance learning, and most have moved out of the dorms and back with family members, lost jobs, and had senior activities and ceremonies canceled. In terms of academics, there has been a sudden shift in the way material is being delivered and graded, and students are trying to keep up. Some students have challenging relationships with family members, so moving back home is not ideal, especially while trying to keep up with coursework. The disappointment of graduation being canceled has had an impact on some students’ mood, which has also impacted motivation. I work at a school with a high percentage of first-generation college students, so having their families be able to witness them graduate is a huge deal for many.

In private practice, I work with mostly professional women of color. Most are fortunate to work from home. For them, the challenges include adjusting to remote work, and continuing to maintain some sense of normalcy—interacting with friends and family, getting exercise, using coping skills, and dealing with relationship issues (family, live-in partners). This is in addition to whatever goals we were working on prior to the pandemic.

How much do you discuss the coronavirus with them?

In terms of the actual virus, it depends to what degree the person’s life has been impacted by it. For the most part, individuals that I work with have not been directly affected by it. There is some level of anxiety about becoming infected, but that is to be expected. For a small percentage, there are concerns about loved ones who have been diagnosed or who are at a high risk of exposure. For them, the work is focused on processing the range of emotions that come with their experience, providing support and validation, managing expectations, challenging negative thinking patterns, and making sure they have accurate information and are using effective coping skills.

What advice do you have for people experiencing anxiety, stress, trauma, etc., because of the pandemic?

This is an unprecedented time, and there are many unknowns. Some level of anxiety is to be expected. Anxiety is often the result of thinking about the worst-case scenario and trying to control things that we can’t. In such a time, it is important to create as much structure as possible and focus on the things we can control.

1. Make a daily schedule, or stick to your usual routine as much as possible.

2. Maintain communication with family and friends. Think about a variety of things to do together in your virtual chats (play games, have spa days, pray or meditate together, have Netflix parties).

3. Continue to maintain good eating and sleeping habits. Usually when we are stressed, we tend to overlook the basics, but it is so important to pay attention to these things. Our bodies need proper nutrition and adequate sleep—lack of these can also have an impact on our mood.

4. Exercise! Even if it is just going for a walk outside. Endorphins, which are released during physical activity, are the body’s natural mood-booster. There are fitness apps that are offering free content, so definitely take advantage! 

5. Practice mindfulness. Thinking about the future and its uncertainties and unknowns can cause one to feel overwhelmed. Practicing mindfulness will help you focus on the here and now. This can help you feel more grounded.

6. Limit exposure to the news and social media. If you want to stay informed, limit the amount of time you spend each day reading or watching the news, and limit it to accurate sources.

7. Practice gratitude. It is easy to get swept up in the difficulties this has brought, but reminding yourself of two to three things you are thankful for each day can help with coping.

8. If you are having trouble managing, find a licensed therapist to help you. Some insurance companies are waiving cost-sharing for teletherapy, so it’s possible that there will be no cost to you if you see an in-network provider. (Check with your insurance company to verify.)

What is teletherapy like? How does it compare with therapy in person? 

Teletherapy can include a phone or video chat. For video chat, therapists use a HIPAA-compliant platform that is encrypted to ensure your confidentiality. Sessions are typically conducted in the same way an in-person session would be done. Providing therapy through any electronic medium is going to feel different than sitting across from someone face to face.

However, it does not mean that it is any less effective. The most important part of any therapy—in-person or virtual—is the establishment of a strong relationship between client and therapist. The strength of the relationship is the strongest predictor of treatment success no matter the delivery method or type of treatment.

How does your work impact your personal mental-health concerns over the pandemic?

I remind myself daily that I am human too and I am going through the same experience as everyone else. Although I am in a position to support others, I have to acknowledge the parts of myself that also worry about my own health and that of my family and friends. I also have to practice good coping skills and have compassion for myself when I have an off day. What also helps is having the support of other clinicians who understand and are willing to lend an ear to listen.

How do you think the pandemic will change how you practice therapy in the future, if it will?

Personally, this has forced me to learn how to use teletherapy and become comfortable with it rather quickly. Prior to the pandemic, I had no experience providing teletherapy. It is not something that most training programs teach us how to do. It does require a different skill set. 

If I am being honest, I had no interest in learning about it. One of the things I enjoy most about therapy is the privilege to sit with someone face to face and be a partner in navigating whatever difficulty they are faced with. I can say that this experience has changed my mind about incorporating it into the services I provide. While there are still some aspects of treatment that I prefer and need to do in person (initial intakes, psychological assessments), I can definitely see myself using teletherapy in the future for individuals who are a good fit for it. 

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—Listen to Leadership Next, a Fortune podcast examining the evolving role of CEOs
—WATCH: The race is on to create a coronavirus antiviral drug and vaccine

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